3. Pain

The evidence of pain. The patient complains of pain, and directs to
its location by placing his hand on the part, or as near to the part
as he can.

How much pain has the patient? He may be sensitive, imaginative,
and inclined to exaggerate; or he may be frightened. On the other
hand, he may be reticent and fail to tell the truth about his
suffering. Again, he may be too ignorant to give a clear account of
himself.

These are a few ways of learning of pain:

(a) Facial expression and bodily movements;

(b) As described by a friend or nurse;

(c) Results, such as weakness and emaciation from long
suffering;

(d) Arterial pressure.

When a patient's face is contorted and his body writhes, doubles
up, or stiffens, we have good evidence; yet he may be malingering
(acting). However, the experienced physician will not be fooled
long. It may take a little watching when the patient thinks he is
alone. If he really suffers, he will suffer alone as well as when
someone is near.

Many are sorry for themselves and make more complaint than
necessary; others complain to secure sympathy. The real physician will
discriminate, while the doctor is never anything but an amateur. The
former cures his patient by imparting assurance; the latter adds to
the disease by first discouraging and then operating.

When a patient who looks well declares he has been suffering for
months, and he has not lost weight, and there are no objective signs,
such as impaired circulation and heart action, and no tumor at the
point where the pain is said to be located, it is safe to treat him as
a malingerer or a self-deluded individual.

If nervous, imaginative, and self-deluded patients, describing
their suffering as "awful ... .. fearful," "I liked to
died last night," "I thought I was a goner," etc., are
examined for patellar reflex, this movement will be found greatly
exaggerated. This proves that they are very sensitive to pain, and
should be questioned regarding eating; and it will be found that they
eat much starch, and use coffee and other stimulants. Many will be
found to have toxin poisoning.

Women bear pain--prolonged pain--better than men. The reason for
this is that they are more self-controlled than men. Man is more
self-indulged, hence less able to stand pain.

Types Of Pain

There are many kinds of pain; namely: boring, tearing, lancinating;
a feeling of pressure, of heat, of cold, of hunger; a feeling of
all-goneness, fullness, emptiness.

Colic is distinctive. It is rhythmic--the patient does not suffer
all the time. It begins gradually, and increases to a climax; then
subsides, to repeat again. Such pains are characteristic of canals:
the intestinal, urethra, ureters, uriniferous tubules, bile-duct,
eustachian tube, uterus, and fallopian tubes. An inflammation of these
tubes and canals is accompanied by rhythmical pain.

Throbbing Pain: Pain that rhythms with the heart and pulse is
caused by hyperemia. Headache and toothache are types. Any
inflammation that is accompanied with enough swelling will have a
rhythmic pain.

Precordial Oppression: This is a feeling of constriction. Angina
pectoris is a type of this pain. This pain is of the heart. Affections
of the pleura or lungs give no such pain. Asthma is a feeling of
suffocation. It differs from oppression in the fact that it is
difficult to draw air into the lungs, whereas in heart oppression
there is no difficulty in getting air into the lungs, but it appears
difficult to extract the oxygen, and the patient feels that he will
die of suffocation.

Reflex Pain: When reflex pain is from angina in the lungs or
abdomen, resembling indigestion, rheumatism, neuralgia, or neurosis,
it may be relieved by rest, but not with the usual palliatives.